Neurological approaches - evaluation and intervention Flashcards
task oriented approached to motor control training
remediation of client factors and environment to improve task performance
motor control is determined by interactive systems, behavioral tasks, and adaptive mechanisms
top down approach
Carr and Shepherd’s motor relearning program (MRP)
the person is an active participant whose goal is to relearn effective strategies for performing functional movement
learning general strategies for problem solving motor problems
no compensatory movements
principles of motor learning
acquisition of functional skills that can be generalized to multiple situations and environments
stages of motor learning:
1. skill acquisition stage (cognitive stage)
2. skill retention stage (carryover)
3. skill transfer (generalization)
overview of neurophysiologic frames of reference
- reflex responses come before controlled movement
- sensory input regulates motor output and sensation is necessary for movement to take place
- use of facilitation and inhibition techniques can improve motor performance
NDT/ the Bobath technique
development of normal patterns of posture and movement
postural reactions are a basis for movement control (righting, equilibrium, protective)
handling is the primary intervention to promote normal movement
proprioceptive neuromuscular facilitation (PNF)
patterns of movement, posture, sensory stimulation, visual cues, verbal commands
normal motor dev occurs in cervicocaudal and proximal-distal direction
early motor behavior is dominated by reflex activity
goal directed activity and facilitation
DIAGONAL patterns of movement (D1 flexion and extension, D2 flexion and extension)
good for Parkinson’s
Brunnstrom’s movement therapy
- facilitating recovery through a specific sequence
- 7 stages of motor recovery following hemiplegia
- developing synergies
Margaret Rood’s approach
- sensorimotor control is developmentally based
- treatment must begin at the person’s current level and progress sequentially
- 4 phases:
1. reciprocal inhibition/innervation (reflex governed)
2. co-contraction (agonist and antagonist contract at same time to provide stability)
3. heavy work (mobility on stability - proximal contract, distal is fixed)
4. skill (highest level of control)
Rood’s 8 ontogenic motor patterns
supine withdrawn, rollover, prone extension, neck contraction, prone on elbows, quadruped, standing, walking
motor response achieved is dependent on the type of sensory stimulation the therapist applies
Stability pattern and Rood – neck co contraction is the first one because it requires simultaneous activation of neck flexors and extensors
assessment for components of motor control
spasticity: quick stretch and measured on the ash worth scale
reflex testing: examples are grasp, flexor withdrawal, crossed extension, ATNR, STNR
qualitative descriptions of motor control
examples of motor control issues resulting in observable poor quality of movement
- intention tremor (at a target in space)
- dysmetria (under/over shooting)
- dyssynergia (breakdown in movement, not smooth)
- dysdiadochokinesia (cannot perform RAM)
- ataxia (loss of motor control)
- resting tremor
- rigidity
- bradykinesia
- akinesia (cannot initiate movements)
- athetosis (writhing)
- dystonia (distorted contraction)
- chorea (spastic involuntary of face and arms)
- hemiballismus (unilateral chorea)
assess subluxation
persons arm dangle
palpate space underneath acromion with your index finger
document the finger width
compare to other side
evaluation of oral motor dysfunction
ROM, strength, and tone of lips, cheeks and tongue
extra and intramural sensation
dentition (integrity of teeth, dentures)
oral control of bolus
swallow reflex
airway protection (gag)
primitive reflexes
cranial nerve testing
swallow studies
CN I
olfactory
smell
test: smell different things
CN II
optic
vision
eye-chart and visual field testing
CN III
oculomotor
motor: medial and vertical eye movements
sensory: proprioception of the eye
test: pupil sizes, visual tracking
CN IV
trochlear
downward and inward eye movements
visual tracking
CN V
trigeminal
motor and sensory for face, mouth, nose, eyes, mastication
control of jaw movements
pain/touch/temp tested with a stimulus
jaw ROM
CN VI
abducens
lateral eye movements
tracking
CN VII
facial
motor fibers to muscles of facial expression and salivary glands
sensory fibers to taste buds and ant 2/3 of tongue
test: facial symmetry, expressions, sweet/sour
CN VIII
vestibulocochlear
acoustic equilibrium and hearing
hearing with tuning fork
CN IX
glossopharyngeal
motor: pharynx and salivary
sensory: posterior tongue
test: gag and swallow, post 1/3 for taste
CN X
vagus
sensory/motor for pharynx and larynx, parasympathetic smooth muscles of abdominal organs
test: with IX
CN XI
spinal accessory
sensory/motor to SCM, trapezius, soft palate
movement of neck and shoulders
SCM and trap MMT
CN XII
hypoglossal
motor/sensory to/from tongue
tongue movement
test: stick out tongue
principles of Ayres sensory integration approach
- plasticity of the CNS allows for modification
- SI occurs in a developmentally sequential manner
- higher cortical processing functions are dependent on adequate processing of stimuli
- modulation of stimuli must occur for an adaptive response
- adaptive responses facilitate integration of stimuli
- individuals seek out sensory experiences that have an organizing effect
evaluation for sensory processing disorders
- sensory integration and praxis test (SIPT)
4-8.11 years, 17 tests tactile, vestibular, prop, visual processing - degangi-berk test of SI (TSI)
3-5 years, focus on vestibular system - test of sensory function in infants (1-18 mo)
- sensory processing measure (SPM) elementary age (includes social participation)
- Sensory profile
intervention for sensory processing
controls sensory input, just right challenge, control the environment, registration of meaningful sensory input to obtain a response, balance structure and freedom, gradually introduce activities that require more complex patterns
firm pressure and resistance is more calming, linear movement, slow movement
severe sensory processing deficits
combination of stimuli must be used to elicit an adaptive response for effective intervention
intervention for tactile deficits
- self applied stimuli is more tolerable
- firm pressure
- child sees the source if you are applying
- apply tactile stimuli in the direction of hair growth
- follow tactile stimuli with joint compression
intervention for proprioception deficits
- firm touch, deep pressure, join compression, traction
- resistance to active movement
- various body positions (yoga)
- weighted vests
intervention for vestibular deficits
- grade for type of rate of movement and amount of resistance
- slowly introduce linear movement in prone
- provide rapid rotary and angular movements with frequent start/stops and acceleration/deceleration to increase ability to distinguish pace of movement (semi circular canals)
**look for signs of autonomic nervous system reactions - sweaty, pupils, respiration, nausea)
motor learning theory
practice and repetition, transfer of learning (practice with Left first then right) – compensatory model would be to adapt the chair with an extension brake
CIMT
- use everyday functional tasks in real or closely simulated environments
- used in conjunction with contemporary motor learning techniques
- includes the assignment of “homework” and practice activities
- activities completed with there therapist and some independently
